title: Survival in pediatric dialysis and transplant patients.
abstract: OBJECTIVE
  Long-term follow-up data are few in children with ESRD. We sought to describe long-term survival, assess risk factors for death, and compare survival between two time periods in pediatric ESRD patients.
  
  
  METHODS
  We used a population-based retrospective cohort utilizing data from a national organ failure registry and from Canada's universal healthcare system. We included 843 children (ages, 0 to 18) initiating renal replacement therapy from 1992 to 2007 and followed them until death or date of last contact (median follow-up, 6.8 years; interquartile range, 3.0 to 10.6). We assessed risk factors for death and examined cause-specific mortality.
  
  
  RESULTS
  During 5991 patient-years of follow-up, 107 (12.7%) patients died. Unadjusted cumulative survival for the cohort was: 91.7% (95% CI, 89.8 to 93.7%) at 5 years and 85.8% (95% CI, 82.8 to 88.8%) at 10 years. Among patients commencing dialysis, overall adjusted survival was poorest among those who started dialysis at age <1 year. No secular trends in survival were noted for either dialysis or transplant patients. The proportion of incident patients receiving pre-emptive transplantation increased over time. Pre-emptively transplanted patients did not demonstrate superior adjusted survival compared with those who spent >2 years on dialysis before transplant (hazard ratio, 1.53; 95% CI, 0.63 to 3.67).
  
  
  CONCLUSIONS
  No significant improvements in survival were observed among ESRD patients over the study period. Time with transplant function had the strongest association with survival. Pre-emptive transplantation was not associated with improved survival in adjusted models.
authors.affiliation: University of Calgary, and Alberta Children’s Hospital, Calgary, Alberta, Canada. s.samuel@albertahealthservices.ca
authors.forename: Susan M
authors.initials: SM
authors.lastname: Samuel
authors.forename: Marcello A
authors.initials: MA
authors.lastname: Tonelli
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Foster
authors.forename: R Todd
authors.initials: RT
authors.lastname: Alexander
authors.forename: Alberto
authors.initials: A
authors.lastname: Nettel-Aguirre
authors.forename: Andrea
authors.initials: A
authors.lastname: Soo
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors